A modified ileal conduit technique in patients undergoing radical cystectomy: Single-centre experience

Objective: We aimed to evaluate perioperative outcomes and complications of a modified technique of ileal conduit diversion. Methods: Forty-seven cases of radical cystectomy with modified ileal conduit diversion were performed at our institution from January 2015 to January 2020. After radical cystectomy, a segment of ileum was used to pack the conduit and was placed below the digestive anastomosis. Then, the mesentery window of the ileo-ileal anastomosis was sutured. The ureters were anastomosed on their native side on single loop ureteral stents. All procedures were performed by a single surgical team. Intra- and postoperative complications were classified and reported according to the Satava and Clavien–Dindo grading systems. Results: The mean age of population was 66.40±10.14 years, and 76.6% were male. Concomitant diabetes was found in 31.9% of patients. About three quarters of patients had T2G3 bladder cancer. Mean blood loss was 449.36±246.50 ml, and hospitalization was 10.32±5 days. With a mean follow-up of 17.36±12.63 months, the recurrence rate was 17%, and 14.9% of patients died of bladder cancer. Out of the 47 patients, three (4.3%) experienced intraoperative complications, while 15 (31.9%) had postoperative complications. Of these, only three patients experienced Clavien–Dindo complications ⩾grade 3. Multivariate logistic regression model showed that diabetes ( p=0.023) and higher blood loss ( p=0.010) were significantly associated with an increased risk of postoperative complications. We reported one case of ureterointestinal anastomosis stenosis on the left side and none on the right side. Despite our results being promising, larger randomized trials with longer follow-up are needed to explore further the feasibility of this technique on a larger scale. Conclusion: We describe a safe and simple surgical technique with a similar postoperative complications rate and a lower incidence of ureteroileal anastomosis stenosis compared to the standard technique. Level of evidence 4.

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Clinical outcome of Laparoscopic and Robot-assisted Radical Cystectomy for Bladder Cancer in a Retrospective Study

10.21203/rs.3.rs-517351/v1 ◽

2021 ◽

Author(s):

YuChen Bai ◽

Shuai Wang ◽

Wei Zheng ◽

Jing Quan ◽

Fei Wei ◽

...

Keyword(s):

Bladder Cancer ◽

Retrospective Study ◽

Postoperative Complications ◽

Blood Loss ◽

Radical Cystectomy ◽

Perioperative Outcomes ◽

Robot Assisted ◽

Long Term Outcome ◽

Estimated Blood Loss

Abstract Background: With the rapid development of surgical technics and instruments, more and more bladder cancer patients are being treated by laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) .The aim of this retrospective study was to compare the perioperative and long-term outcomes of patients who underwent cystectomy by these two surgical approaches. Methods: We performed a retrospective review of the prospectively collected database of our hospital to identify patients with clinical stage Ta/T1/Tis to T3 who underwent RARC and LRC. Perioperative outcomes, recurrence, and overall survival (OS) were analyzed. Results: From March 2010 to December 2019, there were total of 218 patients, which including 82(38%) patients with LRC and 136(62%) patients with RARC. No perioperative death was observed in both groups. Tumor recurrence, death from any causes, and cancer-specific death occurred in 77, 55, and 39 patients respectively. The 5-year DFS, OS, and CSS rates for all included patients were 55.4%, 62.4%, and 66.4%, respectively. There were no significantly statistically differences between the RARC group and the LRC group for number of lymph nodes harvested, positive lymph node rate, positive margin rate and postoperative pathological stage (all P>0.05). Patients undergoing RARC had lower median estimated blood loss (180mL vs. 250 mL; P 0.015) and 90-days postoperative complications (30.8% vs. 46.3%; P 0.013) than LRC.Conclusions: For selected patients with RARC and LRC, both were safe and effective with a low complication rate and similar long-term outcome compared two groups. Moreover, the robotic approach resulted in lower median estimated blood loss and better outcome in postoperative complications.

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Cost of Care in Open Cystectomy Patients Across Time and Space: Does it matter?

Bladder Cancer ◽

10.3233/blc-211580 ◽

2021 ◽

pp. 1-9

Author(s):

Helen H. Sun ◽

Megan Prunty ◽

Ilaha Isali ◽

Amr Mahran ◽

Kevin Ginsburg ◽

...

Keyword(s):

Bladder Cancer ◽

Postoperative Complications ◽

Length Of Stay ◽

Radical Cystectomy ◽

Ileal Conduit ◽

Cost Of Care ◽

Teaching Hospitals ◽

Factors Associated ◽

Open Radical Cystectomy ◽

Inpatient Complication

BACKGROUND: Many variables may affect the cost of open radical cystectomy (RC) care, including surgical approach, diversion type, patient comorbidities, and postoperative complications. OBJECTIVE: To determine factors associated with changes in cost of care following open radical cystectomy (ORC) for bladder cancer using the National Inpatient Sample (NIS). METHODS: Patients in the NIS with a diagnosis of bladder cancer who underwent ORC with ileal conduit from 2012–2017 using ICD-9-CM and ICD-10-CM codes were identified. Baseline demographics including age, race, region, postoperative complications, and length of stay were obtained. Univariable and multivariable logistic regression were used to identify factors associated with cost variation including demographics, clinical characteristics, surgical factors, and discharge quarter (Q1-Q4). RESULTS: 5,189 patients were included in the analysis, with 4,379 at urban teaching hospitals. On multivariable regression analysis, female sex [$1,734 ($1,024–2,444) p < 0.001)], a greater Elixhauser comorbidity score [$93 ($62–124), p < 0.001], presence of any inpatient complication [$1,531 ($894–2,168), p < 0.001], and greater length of stay [$1,665 ($1,536–1,793), p < 0.001] were associated with a greater cost of hospitalization. Discharge in Q3 (July to September) relative to Q2 (April to June) was associated with a higher cost [$1,113 ($292–1,933), p = 0.008. Trends were similar at urban non-teaching and rural hospitals, except discharge quarter was not associated with a significant change in cost. CONCLUSIONS: Significant differences in cost of ORC with ileal conduit exist with respect to patient sex, medical comorbidities, and discharge timing. These differences may relate to greater disease burden in female patients, patient complexity, and variation in postoperative care in academic programs.

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Feasibility and safety of radical cystectomy under combined spinal and epidural anesthesia in octogenarian patients with ASA score ≥3: A case series

Canadian Urological Association Journal ◽

10.5489/cuaj.2063 ◽

2015 ◽

Vol 9 (7-8) ◽

pp. 500 ◽

Cited By ~ 1

Author(s):

Vassilios Tzortzis ◽

Konstantinos Dimitropoulos ◽

Anastasios Karatzas ◽

Ioannis Zachos ◽

Konstantinos Stamoulis ◽

...

Keyword(s):

Bladder Cancer ◽

High Risk ◽

Postoperative Complications ◽

Cancer Patients ◽

Radical Cystectomy ◽

Intraoperative Complications ◽

Case Series ◽

Surgical Trauma ◽

Grade Ii ◽

Grade Iii

Introduction: This study evaluated the feasibility and safety of open radical cystectomy (RC) under combined regional anesthesia (CRA) in high-risk octogenarian patients.Methods: We retrospectively evaluated the medical records of high-risk, octogenarian bladder cancer patients submitted to open RC with CRA. Demographic and clinical data, intraoperative parameters and perioperative and postoperative complications were recorded using the Clavien-Dindo classification.Results: In total, 14 male and 4 female patients, with a median age of 82.5 years were enrolled. Ureterocutaneostomy was performed in 15 patients and Bricker ileal conduit in the remaining 3. Operative time ranged from 97 to 184 minutes. Five patients were transfused and no major intraoperative complications occurred. Postoperative complications 30 days later included ileus (Grade II) in 3 patients, surgical trauma infection in 1 patient (Grade II), respiratory infection in 2 patients (Grade III), and hydronephrosis with concurrent urinary tract infection in 3 patients (Grade III). No deaths occurred.Conclusions: Our study showed that octogenarian, high-risk bladder cancer patients with indications for RC can safely undergo the surgical procedure under CRA, without apparent increase in major complications.

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Immediate Radical Cystectomy for Massive Bleeding of Bladder Cancer

BioMed Research International ◽

10.1155/2015/154392 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Giovanni Cochetti ◽

Francesco Barillaro ◽

Andrea Boni ◽

Ettore Mearini

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Intraoperative Complications ◽

Surgical Margin ◽

Oncologic Outcomes ◽

Positive Surgical Margin ◽

Transfusion Rate ◽

Tertiary Institution ◽

Cancer Specific Survival

Objective.To investigate feasibility and safety of our surgical strategy and clinical and oncological efficacy.Materials and Methods.In a high volume tertiary institution 225 radical cystectomies were performed from January 2012 to December 2014. We prospectively collected data of a cohort of 12 patients who underwent immediate open radical cystectomy for bladder cancer causing massive haematuria, acute anemia, and impossibility of postponing surgery. A retrospective study was carried out to evaluate operative data, intra- and postoperative complications, and oncologic outcomes. The Clavien-Dindo Classification was used to grade complications. The oncologic outcome was evaluated in terms of positive overall and soft tissue surgical margins and cancer specific survival at a median follow-up of 26 months.Results.Mean preoperative haemoglobin was 6.8 mg/dL. Mean operative time was 278 minutes. Mean blood loss was 633 mL. The overall transfusion rate was 100% with a mean of 3.6 blood units per patient before surgery and 1.8 units postoperatively. No intraoperative complications occurred. Major complications (defined as grades III, IV, and V according to Clavien-Dindo Classification) were 18,5%. In fact grade III complications were 14.8% and grade IV complications were 3.7%. Grade V did not occur. The positive surgical margin rate was 33.3% and cancer specific survival was 58,3% at median follow-up of 26 months.Conclusions.Immediate surgical management seems feasible, safe, and efficacious.

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The LACE Score as a Tool to Identify Radical Cystectomy Patients at Increased Risk of 90-Day Readmission and Mortality

Current Urology ◽

10.1159/000447226 ◽

2018 ◽

Vol 12 (1) ◽

pp. 20-26 ◽

Cited By ~ 2

Author(s):

Jennifer L. Saluk ◽

Robert H. Blackwell ◽

William S. Gange ◽

Matthew A. C. Zapf ◽

Anai N. Kothari ◽

...

Keyword(s):

Bladder Cancer ◽

High Risk ◽

Radical Cystectomy ◽

Multivariable Analysis ◽

Emergency Department Visits ◽

High Risk Patients ◽

Increased Risk ◽

Patients At Risk ◽

Risk Patients

Introduction: Radical cystectomy for bladder cancer is associated with high rates of readmission. We investigated the LACE score, a validated prediction tool for readmission and mortality, in the radical cystectomy population. Materials & Methods: Patients who underwent radical cystectomy for bladder cancer were identified by ICD-9 codes from the Healthcare Cost and Utilization Project State Inpatient Database for California years 2007-2010. The LACE score was calculated as previously described, with components of L: length of stay, A: acuity of admission, C: comorbidity, and E: number of emergency department visits within 6 months preceding surgery. Results: Of 3,470 radical cystectomy patients, 638 (18.4%) experienced 90-day readmission, and 160 (4.6%) 90-day mortality. At a previously validated “high-risk” LACE score ≥ 10, patients experienced an increased risk of 90-day readmission (22.8 vs. 17.7%, p = 0.002) and mortality (9.1 vs. 3.5%, p < 0.001). On adjusted multivariable analysis, “high risk” patients by LACE score had increased 90-day odds of readmission (adjusted OR = 1.24, 95% CI: 0.99-1.54, p = 0.050) and mortality (adjusted OR = 2.09, 95% CI: 1.47-2.99, p < 0.001). Conclusion: The LACE score reasonably identifies patients at risk for 90-day mortality following radical cystectomy, but only poorly predicts readmission. Providers may use the LACE score to target high-risk patients for closer follow-up or intervention.

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Pathological Profile, Early Complications, Functional and Oncological Outcome after Radical Cystectomy - Ileal Conduit for Bladder Cancer Patients in Sanglah General Hospital between January 2013 and December 2016

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.384 ◽

2018 ◽

Vol 6 (9) ◽

pp. 1647-1651 ◽

Cited By ~ 1

Author(s):

Yudiana Wayan ◽

Pratiwi Dinar Ayu ◽

Oka A. A. Gde ◽

Niryana Wayan ◽

I Putu Eka Widyadharma

Keyword(s):

Bladder Cancer ◽

Cancer Patients ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Ileal Conduit ◽

Wound Dehiscence ◽

Oncological Outcome ◽

Pathological Result ◽

Muscle Invasive

BACKGROUND: Radical cystectomy is the standard treatment for nonmetastatic bladder cancer (muscle-invasive and selective superficial bladder cancer). There are many types of urinary diversion after this procedure; the ileal conduit is the most and simplest one. AIM: To asses clinical, pathological profile, early complication, functional and oncological outcome after radical cystectomy and ileal conduit for muscle-invasive bladder cancer patients. METHOD: Between January 2013 and December 2016, there were 68 patients diagnosed with bladder cancer. From those patients, 24 (35.29%) patients had been performed radical cystectomy with ileal conduit type for urinary diversion (100%). Patients demographic, clinical and pathological profile, early postoperative complication, functional and oncological outcome were collected from the medical record. RESULT: Among the 24 patients who underwent radical cystectomy, 20 patients were male (83.3%) with the mean age was 57.3 y.o (33–77 y.o). Twelve patients (50%) showed pT4 and pT2 respectively. Based on pathological result 20 patient (83.34%) had the urothelial carcinoma, three patients (12.5%) had squamous cell carcinoma, and one patient (4.1%) had adenocarcinoma. Two patients (8.3%) got neoadjuvant chemotherapy, and nine patient (37.5%) of patients followed adjuvant chemotherapy after surgery. Wound dehiscence, fistula enterocutan, prolong ileus, leakage anastomosis and sepsis were kind of complication after surgery. One year's survival rate is 84%, mortality rate 20.8% and a recurrence rate of 20.8% in 4 years follow up. CONCLUSION: Radical cystectomy and ileal conduit type of urinary diversion still become the preferable procedure for nonmetastatic bladder cancer with good functional and oncological outcome.

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Technique selection of ureteroileal anastomosis in hautmann ileal neobladder with chimney modification: Reliability of patient-based selection strategy and its impact on ureteroentric stricture rate

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2021.3.262 ◽

2021 ◽

Vol 93 (3) ◽

pp. 262-267

Author(s):

Dejan Djordjevic ◽

Svetomir Dragicevic ◽

Marko Vukovic

Keyword(s):

Postoperative Complications ◽

Radical Cystectomy ◽

Long Term Results ◽

Perioperative Outcomes ◽

Selection Strategy ◽

Ileal Neobladder ◽

Stricture Rate ◽

Group I ◽

Group Ii

Objective: We aimed to establish the reliability of technique selection strategy for ureteroileal anastomosis (Bricker vs. Wallace) by comparing perioperative outcomes, complications, and anastomotic stricture rate in a contemporary series of patients who underwent open radical cystectomy followed by reconstruction of modified Hautmann neobladder. Materials and methods: A total of 60 patients underwent radical cystectomy and modified Hautmann neobladder, of whom 30 patients (group I) with Bricker anastomotic technique were compared to 30 matched paired patients with end-to-end ureteroileal anastomosis (group II). Long-term results, including ureteroileal stricture (UIS) and postoperative complication rate at two year follow up were available. The choice of anastomosis type was successively based on chimney size, ureteral length after retro-sigmoidal tunneling and diameter of distal ureter. Postoperative complications were graded according to the Clavien-Dindo system. Results: Ureteroileal stricture rate was 6.6% in group I vs. 0% in group II, after three months (p < 0.05), while anastomotic leakage rate was 6.6% vs. 3.3% (group I vs group II) between the two groups for the same follow up period (p > 0.05). High-grade complications (Clavien III-V) were more in Bricker group as compared to Wallace group and the difference was significant (20% vs 10.3%, p = 0.03). Conclusion: Our preliminary outcomes demonstrate that this selection strategy seems to be clinically reliable, with lower incidence of postoperative complications in Wallace group.

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Sarcopenia as a predictor of perioperative outcomes following radical cystectomy in a contemporary cohort of patients with bladder cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e16031 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e16031-e16031

Author(s):

Nicholas Brent Drury ◽

William Mills Worrilow ◽

Hamza Mustafa Beano ◽

Myra M. Robinson ◽

Jeffrey Ignatoff ◽

...

Keyword(s):

Bladder Cancer ◽

Radical Cystectomy ◽

Care Pathway ◽

Perioperative Outcomes ◽

International Consensus ◽

Consensus Definition ◽

Cancer Specific Survival ◽

Perioperative Care Pathway ◽

The Impact

e16031 Background: Sarcopenia has gained considerable recognition as an important prognostic factor for complications, longer hospital stay, and survival following cystectomy for bladder cancer. However, inconsistent cutoff values to define sarcopenia have been utilized throughout the literature. Our aim was to evaluate sarcopenia as a predictor of outcomes following radical cystectomy with urinary diversion (RCUD) using the international consensus definition, Martin criteria, and Mayr criteria, as a standardized cutoff value would potentially reduce bias across studies. Methods: A retrospective analysis of patients treated with RCUD at our institution between 2010 and 2017 was performed. Sarcopenia was defined according to the aforementioned criteria and assessed by measuring total psoas area (TPA) on preoperative computerized tomography. The impact of sarcopenia on perioperative outcomes, cancer-specific survival (CSS), and overall survival (OS) was evaluated with univariate and multivariate regression models. Results: Of 258 patients who underwent RCUD, 195 had available computed tomography scans within 90 days of surgery. The median TPA scores among men and women were 578.0 and 459.6 mm2/mm2, respectively. The overall incidence of sarcopenia according to the international consensus definition, Martin criteria, and Mayr criteria was 36.4% (71/195), 24.1% (47/195), and 31.3% (61/195), respectively. Regardless of definition, significant differences were not observed in length of stay, high grade complications, readmissions, and discharge destination (all P > .05). Furthermore, sarcopenia was not significantly associated with CSS or OS. The median follow-up time was 4.1 years (95% CI: 3.6 - 4.4). The 5-year CSS and OS were 46.3% and 66.2%, respectively. Conclusions: Irrespective of definition, we were unable to externally validate sarcopenia as a predictor of perioperative outcomes in our contemporary cohort. Future studies will evaluate the impact of our evolving perioperative care pathway on oncological outcomes, including its ability to mitigate the effects of sarcopenia through reducing the physiological and mental demands of surgery.

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Three-port approach vs standard laparoscopic radical cystectomy with an ileal conduit: a single-centre retrospective study

BMC Urology ◽

10.1186/s12894-021-00920-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhouting Tuo ◽

Ying Zhang ◽

Jinyou Wang ◽

Huan Zhou ◽

Youlu Lu ◽

...

Keyword(s):

Radical Cystectomy ◽

Operative Time ◽

Ileal Conduit ◽

Oncological Outcome ◽

Perioperative Outcomes ◽

Post Surgery ◽

Estimated Blood Loss ◽

Muscle Invasive

Abstract Background This study aimed to evaluate the effect of the three-port approach and conventional five-port laparoscopic radical cystectomy (LRC) with an ileal conduit. Methods Eighty-four patients, who were diagnosed with high-risk non-muscle-invasive and muscle-invasive bladder carcinoma and underwent LRC with an ileal conduit between January 2018 and April 2020, were retrospectively evaluated. Thirty and fifty-four patients respectively underwent the three-port approach and five-port LRC. Clinical characteristics, pathological data, perioperative outcomes, and follow-up data were analysed. Results There were no differences in perioperatively surgical outcome, including pathology type, prostate adenocarcinoma incidence, tumour staging, and postoperative creatinine levels between the two groups. The operative time (271.3 ± 24.03 vs. 279.57 ± 48.47 min, P = 0.299), estimated blood loss (65 vs. 90 mL, P = 0.352), time to passage of flatus (8 vs. 10 days, P = 0.084), and duration of hospitalisation post-surgery (11 vs. 12 days, P = 0.922) were no clear difference between both groups. Compared with the five-port group, the three-port LRC group was related to lower inpatient costs (12 453 vs. 14 134 $, P = 0.021). Our follow-up results indicated that the rate of postoperative complications, 90-day mortality, and the oncological outcome did not show meaningful differences between these two groups. Conclusions Three-port LRC with an ileal conduit is technically safe and feasible for the treatment of bladder cancer. On comparing the three-port LRC with the five-port LRC, our technique does not increase the rate of short-term and long-term complications and tumour recurrence, but the treatment costs of the former were reduced.

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